Action Points

Note that this observational study showed high variability with regard to the provision of smoking-cessation pharmacotherapy for patients hospitalized with coronary artery disease.

Trends over time have revealed a slight increase in the SCP-provision rate, but large deficits remain.

Smokers who were hospitalized for cardiac events were highly motivated to kick the habit, but initiation of in-hospital smoking cessation therapy is still low among these patients, researchers reported.

In a retrospective study of data from 282 U.S. hospitals, just over one in five (22.7%) smokers hospitalized for coronary heart disease (CHD) received a smoking cessation pharmacotherapy during their hospital stay, according to Quinn Pack, MD, of Baystate Medical Center in Springfield, Mass., and colleagues in JAMA Internal Medicine.

There was also wide variation across hospitals in smoking cessation therapy initiation, with the best performing hospitals initiating treatment in around two-thirds of smokers hospitalized for CHD events, and the worst performing initiating therapy in less than 10%, Pack told MedPage Today.

"The hospital was a more important predictor of receiving smoking cessation counseling and treatment than the patient," Pack said. "We saw big hospitals, small hospitals, urban, not urban all vary widely across the range, and none of these variables were predictive."

A similar study in JAMA Cardiology also found a low prevalence of smoking cessation medication use in older heart attack patients following hospitalization.

In that study, just 7% of MI patients who were Medicare beneficiaries filled prescriptions for a smoking-cessation drug within 90 days of hospital discharge.

Pack said the two studies together suggest that, "we are really missing the boat when it comes to helping patients at this very critical time. This is really about the administration and the hospital culture. Some hospitals are really pushing this, and at others, smoking cessation treatment doesn't seem to be on the radar."

The current analysis involved hospitals across the nation participating in Premier Alliance, a large hospital quality improvement database.

Active smokers admitted to hospitals with a principal diagnosis of MI, or who received percutaneous coronary intervention or coronary artery bypass surgery, were included in the analysis. The main outcome was initiation of varenicline tartrate; bupropion hydrochloride; and/or nicotine replacement therapy, including nicotine patch, gum, lozenge, and inhaler.

Using hierarchical generalized logistic regression modeling, the researchers identified independent patient and hospital factors associated with receipt of smoking cessation pharmacotherapy (SCP). Median odds ratio was used to quantify the influence of the hospital on the patient's chance of receiving the pharmacotherapy, and 11-year trends in SCP were examined.

A total of 36,675 smokers with CHD (mean age of 58, 69% male, 63% with MI) were included in the analysis.

According to the authors, 8,316 patients (22.7%) received at least one SCP during the hospitalization.

The most common medication was nicotine patch (20.4%) at a median dosage of 21 mg/d. Additional therapies included nicotine gum (0.3%), lozenge (0.04%),and inhaler (0.2%); bupropion (2.2%); and varenicline (0.4%).

The across-hospital variation on SCP initiation was great, with a median (10th-90th percentile) treatment rate of 22.3%(9.6%-36.7%), the authors reported.

The 11-year SCP trend analysis revealed a 6% absolute increase in mean hospital SCP rate between 2004 and 2011, but only a 2% increase from 2011 to 2014.

"Hospitalization for a cardiac event provides a teachable moment with high patient motivation to quit smoking; however, our findings suggest that many hospitals are missing this opportunity to improve outcomes for smokers hospitalized for CHD," Pack's group wrote.

Although the analysis did not explore why some hospitals had much higher rates of smoking cessation treatment initiation among CHD patients, Pack told MedPage Today that having a smoking cessation protocol in place, and having smoking cessation counsellors on staff, may be important strategies for achieving this outcome.

"We know these medications work. They can really make a big difference for these patients," he said.

The study was funded by the National Center for Advancing Translational Sciences and the National Heart, Lung and Blood Institute.

Pack disclosed no relevant relationships with industry. One co-author disclosed relevant relationships with UptoDate and Pfizer.

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